More about HIV/AIDS

HIV, or human immunodeficiency virus, is a bloodborne virus that causes acquired immune deficiency syndrome, or AIDS, the clinical name of a syndrome that was first reported in the United States in 1981 and is recognized as a great pandemic.

AIDS is one of the most dangerous health problems of modern times. Because of the complexity of this disease, and the rapid development of new treatment strategies, treating AIDS should be carried on with the advice and care of an expert in this area. Preventing the spread of AIDS, however, is straightforward and a responsibility that each person can and should undertake.

HIV attacks the body’s immune system and can eventually destroy it. A severely impaired immune system leaves the infected person increasingly unable to fight off invading bacteria and viruses, and thus susceptible to a whole host of "opportunistic" infections and diseases that are often debilitating and can eventually cause death. The Centers for Disease Control and Prevention (CDC) has cited nearly 30 diseases and sets of symptoms associated with AIDS in the United States. These include Kaposi’s sarcoma (a form of skin cancer), tuberculosis, pneumonia and certain neurological disorders such as meningitis.

A diagnosis of AIDS is based on the type and severity of symptoms in the presence of HIV infection. Another criterion used to designate AIDS is a significant decline in a person’s T-cells—white blood cells that are critical to a healthy immune system. In many infected people, AIDS can be slow to develop, and the full effects of the disease may not appear until 8 to 12 years or more after the initial infection. In children, the time between exposure to HIV and the appearance of symptoms can be measured in months if the infection goes untreated.

So far there is no cure, and no vaccine to prevent the disease. New vaccines are in various phases of testing, but making a successful vaccine has proved to be very difficult. The development and availability of new medications have allowed increasing numbers of HIV-infected people—both children and adults—to delay the onset of symptoms, for years in many cases. These treatments have also slowed the course of the disease for those who have developed AIDS, improving the quality of their lives and enabling them to live longer.

During 1996, the number of AIDS-related deaths in the United States decreased substantially for the first time since the epidemic began in 1981—a nationwide decline of about 25 percent from the previous year that Federal officials attributed to the success of drug therapies that was introduced, along with better access to care and increased financing for AIDS treatment.

This downward trend in AIDS-related deaths, as well as a decline in new cases, continued for the next several years, but the numbers then began leveling off. According to CDC estimates, the HIV incidence among persons aged 13 years and older was 48,100 in 2009. The estimates imply that total HIV incidence in the US has been comparatively stable at about 50,000 annual infections from 2006 to 2009.

AIDS is more prevalent in many developing countries, particularly sub-Saharan Africa and parts of southeast Asia, than it is in the United States. Worldwide, approximately 36 million people are living with HIV or AIDS, with an estimated 15,000 new infections occurring each day. But even in the United States, some 650,000 to 900,000 residents—of whom more than 200,000 are unaware of being infected, are living with HIV infection. And the CDC estimates that four to five million Americans are at high risk for becoming infected because of their sexual behavior and drug use practices.

Once HIV destroys a sufficient amount of the body’s immune system, cancer or certain infections, such as a specific type of pneumonia, can then gain a foothold

What Causes HIV Infection/AIDS?

HIV is an infectious agent known as a retrovirus, which has the ability to take over certain cells and interrupt their normal genetic functioning. Although there is much that we don’t yet understand about HIV, there is a good deal we do know. The virus can be cultured in a laboratory, and scientists have devised reliable tests to detect its presence in blood samples. We also know that the virus is hard to transmit. This is because HIV dies very quickly once it is outside the body. Consequently, it is not transmitted through air or water, nor does it travel easily from person to person, as other infections may. It cannot penetrate intact human skin, and it cannot be spread by casual contact such as touching or hugging, sharing food or a drinking glass, using the same towel, or sharing bathrooms or toilets.

Rather, the virus is carried in bodily fluids such as blood, semen, vaginal fluids, and breast milk, and it can only be spread by the bodily exchange of these fluids with an infected person.

The most common path of HIV transmission is during sexual activity, when the virus in semen or cervical secretions enters cuts or small abrasions. The virus passes from one person to another during anal intercourse more efficiently than it can during vaginal intercourse, and it also passes—though rarely—during oral sex. The virus can also be spread via blood-contaminated hypodermic needles and syringes, and—if donated blood is contaminated—blood transfusions. In addition, an infected mother can pass the virus to her child in utero or during delivery. (Although the virus has been found in saliva and tears, scientists believe that transmission via these fluids is unlikely since the virus is present in very low concentrations.)

In Africa and Asia, AIDS is primarily a heterosexual disease. Worldwide, more than 80 percent of all adult HIV infections have resulted from heterosexual intercourse. During the 1980s in the United States, AIDS was confined primarily to certain well-defined risk groups—males who have sex with males, injection drug users, and people with hemophilia (because they need frequent transfusions). But the number of people infected by heterosexual intercourse began rising in the 1990s.

Of new infections among women in the United States in year 2009, the CDC estimates that 27 percent were infected through heterosexual sex. And while the rate of infection by this route is still comparatively low among men (about 15 percent of new cases), for both men and women the risk increases with frequency of intercourse and especially with multiple partners.

Should You Be Tested for HIV?

If you answer yes to any of the following questions, you should seek counseling and testing for HIV.

Have you had unprotected sex (that is, without a condom) with someone whom you can’t be sure is not infected with HIV?

If you’re a man, have you had unprotected sex (anal sex) with other men?

Have you shared needles or syringes to inject drugs?

Have you had a sexually transmitted disease?

Have you had unprotected sex with someone who would answer yes to any of the above questions?

You should also consider the factor of blood transfusions. Did you receive a blood transfusion or clotting factor between 1978 and 1985? Some recipients of blood transfusions between the fall of 1978, when HIV first appeared in the United States, and May 1985, when blood-donor screening became routine, were at risk for infection, particularly if they received the blood in San Francisco or New York City or if they had multiple transfusions. People with hemophilia, who also were recipients of donated-blood products, may also have been at risk during those years. Since 1985 the risk of contracting an infection from transfusions or blood products has been minimized thanks to the rigorous screening of donated blood.

In addition, if you have had sex with someone and you didn’t know his or her past behavior, or you have had many sex partners, you should consider testing. If you have any doubts about what to do, get counseling. If you are at risk and decide not to be tested, you should assume that you might be infected and take precautions to prevent transmitting the virus to others.

Where To Go For HIV Testing

If you wish to be tested, contact your doctor, local health department, local AIDS organization, or the CDC’s National AIDS Hotline (800-342-AIDS). You can be tested in your doctor’s office or at publicly funded HIV testing sites, community health clinics, family planning clinics, hospital clinics, and drug treatment centers. The complete test is free at some public health clinics; other clinics charge a fee of $40 to $70, depending on where you live. Results are typically available in one to two weeks; to obtain results more quickly, or to have testing done at a private doctor's office, can cost anywhere from $100 to $250, depending on who does it and where you live. You can also do a home test.

Before being tested you should receive proper counseling about the test and HIV, as well as about the meaning and confidentiality of the results. Unless you are tested anonymously, your results may become part of your medical record and may become known to insurance companies, which could affect your future coverage. A counselor can tell you how to avoid this.

After the test, you should receive further counseling. If you test positive, you’ll need to know what your medical options are, how to prevent spreading the disease, and what the psychological, financial, and social repercussions may be.

If you test negative, you’ll need to know how to stay uninfected. Also, if you are in the “window” period (when you could be infected but can still test negative), and if your exposure to the virus is considered to have been high risk, you will be advised about repeating the test within six months from your last HIV exposure.

A new website for HIV testing information has been set up by the CDC (and maintained by the CDC National Prevention Information Network, or NPIN) at www.hivtest.org.

What If You Do Nothing?

If you think you may have been exposed to HIV infection or you have developed symptoms that might be AIDS-related, there are clear benefits to diagnosing HIV infection early.

Promising new drugs can slow the progress of HIV, and other drugs can prevent, delay, or treat opportunistic diseases that strike people with AIDS. There are also better ways to monitor the progress of the disease. For a pregnant woman who is infected with HIV, early treatment with antiviral drugs can reduce by two-thirds or more the chances that her baby will be infected with the virus.

Testing has proved to be very accurate. The most commonly used test is a fairly simple blood test, and if it detects antibodies to the virus, it is followed by a confirmatory blood test. The Food and Drug Administration (FDA) has approved an accurate oral antibody test that uses a special pad to absorb material (not saliva) from the cheek and gum.

The confidentiality of the test results is easier to ensure. Not only are there clinics that offer anonymous testing, but accurate, anonymous home testing is available.

Because of these benefits, anyone who might be at risk should know his or her HIV status. Yet as many as one-third of all HIV-positive Americans do not know they are infected. At the very least, each of us should be familiar with—and know when to use—safer sex practices and other measures for preventing transmission of HIV.

Home Remedies for HIV Infection/AIDS

There are no home remedies for AIDS. If you think you have HIV infection or AIDS, you should always consult a qualified practitioner, who can advise you and help provide medical treatments that may be able to offset or delay symptoms.

Home Testing for HIV

For years, the Food and Drug Administration (FDA) and AIDS advocacy groups opposed home testing, largely because of fears that counseling via telephone would not be adequate. Indeed, people testing positive for such a terrible infection ideally should get face-to-face counseling and, if needed, crisis intervention. But after the FDA studied other forms of telephone counseling and crisis intervention, it decided that the potential benefits (easier access and greater privacy) of the home test outweighed the risks.

The only home test approved by the FDA has been the Home Access test (sold in drugstores and via a toll-free phone number: 800-HIV-TEST). More than a dozen unapproved tests are also on the market, but there’s no guarantee that these are reliable or accurate. (If you have a question about an HIV home test kit, you can call the FDA’s Office of Special Health Issues at 301-827-4460.)

The test simply involves pricking your finger and putting drops of blood on a card with an ID number. You mail the card to a certified lab and wait about a week, then call a toll-free number for the results, using your ID number.

If you test negative (that is, you are not infected), you’ll get a recorded message that includes an explanation of the “window” period—the time when you may be HIV-infected but still have a negative antibody test. If you test positive, you’ll get the news from a trained counselor, who can answer questions and supply detailed information, as well as referrals for counseling and treatment. Conversations are anonymous and confidential.

Testing and face-to-face counseling by a trained health-care professional are undoubtedly preferable to the home test, so if you’re considering the test, it’s a good idea to talk to your doctor or call the CDC’s National AIDS hotline. But the home test is a decent alternative, provided the process helps educate people about HIV/AIDS and leads to medical treatment, if they need it.

Prevention

Until a vaccine can be developed, halting the spread of AIDS must depend solely on educating those at risk—which includes all sexually active people, particularly those who have not lived in strict, long-term monogamy. Though education may not be the ultimate weapon, it is an effective and powerful means of controlling the spread of the disease.

One common myth about AIDS is that it is a disease of male homosexuals and injection drug users; other people have nothing to worry about. It is true that the vast majority of reported AIDS cases in the United States continues to be homosexual or bisexual men or injection drug users. But while these two main risk groups remain for the moment well defined, anybody who has unprotected sex can get AIDS. When it is transmitted heterosexually, women appear to be at greater risk than men: the virus is far less likely to pass from woman to man during vaginal intercourse than from man to woman. Between 120,000 and 160,000 American adult and adolescent women have been infected, and the number is rising sharply, especially among low-income African Americans and Latinas. As of 2009, women accounted for 57 percent of AIDS cases reported nationally.

The frequency of sexual contact appears to be more important than the form. Though a single contact can spread HIV, people who have multiple sexual partners are in much more danger than those with fewer partners. Prostitutes, both male and female, are more likely to be infected by HIV and to transmit it, since in addition to frequent exposure, many use injectable drugs.

Ultimately, it is not who you are, but what you do and with whom you do it, that puts you at risk for contracting HIV. The following are known to be high-risk practices.

Sharing drug needles or syringes.

Anal sex with someone who might carry HIV. The virus is passed easily during anal sex.

Unprotected vaginal or oral sex (without a condom) with someone who might carry HIV. Obviously, the more times you have unprotected sex, the greater your risk. Sex with prostitutes is particularly risky.

With that in mind, here are steps you should take to prevent AIDS.

Choose your sexual partners carefully. Ask about the sexual history of a potential partner. Any person who has had multiple partners or has a sexual relationship with someone who has multiple partners may be at risk. Unless you and your sex partner are both sure you are not infected, you need to take precautions: use condoms, and avoid high-risk practices such as anal intercourse. Couples who have not been monogamous may wish to consider testing.

Always use a latex condom. Used consistently and correctly, latex condoms provide a highly effective HIV preventive: the virus cannot penetrate an intact latex condom. (“Natural membrane,” or skin, condoms are not effective.) Adequate lubrication with a water-based lubricant (such as K-Y jelly) is important to prevent condom breakage. Unless you are certain that you and your sexual partner have not been exposed to AIDS, using condoms must be habitual for any and all episodes of sexual intercourse.

Don’t rely on spermicide. The evidence that spermicides protect against HIV and other sexually transmitted diseases is not conclusive—and spermicide use may actually increase the risk of transmitting HIV by causing inflammation in vaginal tissue. The CDC does not recommend using spermicides alone. Condoms are the first line of defense—but not lubricated with nonoxynol-9. Still, if all you have at hand is a condom with nonoxynol-9, it is better than no condom.

Don’t inject recreational drugs. If you do, never share needles.

Age is no barrier against infection. The number of AIDS cases diagnosed in people over 50 has climbed steadily through the AIDS epidemic, reaching 78,000 through the end of 1999. Gay men represent the majority of the over-50 AIDS cases, but many cases are low-income women who contracted HIV through drug use or heterosexual partners.

Health-care workers should take precautions. Accidental self-puncture with an HIV-infected needle is a possible danger for doctors, nurses, dentists, physician’s assistants, and laboratory workers who give injections or handle blood. However, the number of infections acquired in health-care settings is quite small: as of December 2001, 57 cases and 138 possible cases of HIV infection due to exposure in a health-care setting were documented by the CDC. (In fact, health-care workers are at considerably greater risk of becoming infected with hepatitis B and C.)

If you are infected with HIV, follow these same preventive measures. It is incumbent upon anyone who is infected to avoid exposing others to HIV. In addition, anyone who is HIV-positive and contemplating parenthood should be aware that there is a high risk—from one in three to one in two—of an infected mother transmitting the virus to a fetus or newborn (though early treatment with medications can help reduce the risk).

Beyond Home Remedies: When To Call Your Doctor

You should call your doctor if you suspect you have been at risk for exposure to HIV, whether or not you have symptoms. If you wish, you can first take a home test. Be aware that the antibodies to the virus—which is what the blood test measures—can take six months to develop after the initial infection, so a negative result (indicating that the virus isn’t present) is not reliable. If you have taken the test soon after possible exposure to HIV and tested negative, follow up with another test four to six months later.

If you do home testing and the result is positive (indicating you are infected), it is vital that you consult a physician or a counselor who specializes in HIV and AIDS.

If you have been diagnosed with HIV or AIDS and are undergoing treatment, discuss with your doctor what criteria to use for monitoring and assessing your condition.

What Your Doctor Will Do

Your doctor will examine you to determine the extent and possible cause of any symptoms, including taking a history to determine if you should be tested for HIV (or lab tested to confirm the results of a home test). The doctor will want to know when you think you were exposed to the virus, since there is a time lag, or “window,” during which a person can be infected with HIV but will test negative.

Testing is fairly simple. A blood sample is taken from the arm and analyzed in a laboratory. What the test detects is not the presence of HIV, but rather the antibodies that the immune system produces after the virus enters the bloodstream. The first stage of the testing is known as ELISA (enzyme-linked immunoabsorbent assay). Should it prove positive, it may be repeated to confirm accuracy. After one or more positive ELISA tests, usually a more specific confirmatory test, called the Western blot, is performed. Other tests are also available, some of which don't involve drawing blood. You can discuss these with your doctor.

If testing confirms a diagnosis of HIV, your doctor will talk to you about treatment options, further testing to determine the extent of your infection, and methods to prevent opportunistic infections. If your doctor is not experienced in diagnosing and treating HIV/AIDS, he or she should refer you to an HIV/AIDS specialist. Efforts will also be made to treat existing symptoms, reduce the risk of infections, and maintain proper nutrition.

Your doctor can also help you find an AIDS support network to help provide emotional support and information.